Pain Relief

Question 1

What are the three classes of analgesics

Answer 1

Non opioid
Opioid
Adjuvant

Question 2

Eg non opioid analgesics

Answer 2

Paracetamol

NSAID

Question 3

Eg opioid analgesics

Answer 3

Codeine

Morphine

Question 4

EG adjuvants

Answer 4

Antidepressants

Antiepileptics

Question 5

What are the two main considerations for moderate pain

Answer 5

Codeine phosphate

Tramadol hydrochloride

Question 6

What is good for pain relief of bone mets

Answer 6

Radiotherapy
Bisphosphonates
Radioactive isotopes of strontium chloride

Question 7

Main things used for nerve pain

Answer 7

Gabapentin or pregabalin

Question 8

Pain caused by nerve compression

Answer 8

Dexamethasone

Question 9

What are the two types of preparations of morphine

Answer 9

Immediate release

Modified release

Question 10

How often is immediate release morphine usually given orally

Answer 10

4 hourly

Question 11

How often is modified release morphine usually given orally

Answer 11

12 hourly

Question 12

How do you treat breakthrough pain

Answer 12

Immediate release morphine as a rescue dose

Question 13

When should an additional dose of morphine be given

Answer 13

30 minutes before an activity that causes pain

Question 14

How do you calculate the dose of the opioid for breakthrough pain

Answer 14

1/10 to 1/6 of the regular 24 hour dose repeated every 2-4 hours as required

Question 15

When is a review of pain mgt needed

Answer 15

If needing more than 2 rescue doses for breakthrough pain

Question 16

How do you increase morphine

Answer 16

Increments Should not exceed 1/3 to 1/2 of the total daily dose every 24 hours

Question 17

What is the usual dose required for patients on morphine

Answer 17

IR 30mg 4 hourly
Or
MR 100mg 12 hourly

Question 18

What is the maximum a patient may require for morphine

Answer 18

IR 200mg 4 hourly
Or
MR 600mg 12 hourly

Question 19

How to start morphine

Answer 19

Give immediate release 4 hourly first then once pain controlled switch to equivalent dose of modified release 12-24 hourly

Question 20

What should be prescribed routinely with morphine

Answer 20

Laxative

Question 21

What are the main side effects of morphine that should be monitored for

Answer 21

Constipation nausea and vomiting

Question 22

What is used if a patient cannot tolerate morphine

Answer 22

Oxycodone hydrochloride

Question 23

Are codeine and tramadol equivalent doses

Answer 23

Yes

Question 24

How to convert codeine or tramadol to morphine oral

Answer 24

Morphine is a tenth of the dose orally

Question 25

How to convert the oral morphine dose to IM IV or SC

Answer 25

Divide by 2 (half of the oral dose)

Question 26

How to convert morphine to oxycodone

Answer 26

Oxycodone dose is equivalent to 2/3 of the morphine dose

Question 27

How do you convert morphine to hydro morphone

Answer 27

Hydro morphine is a fifth of the dose of oral morphine

Question 28

How to convert codeine to dihydrocodeine

Answer 28

It’s equivalent!

Question 29

What are the two forms of morphine that can be given parenterallg

Answer 29

Morphine | Diamorphine

Question 30

How to convert oral morphine dose to the equivalent diamorphine dose to be given subcut

Answer 30

1/3 of the oral dose of morphine

Question 31

What pain relief can be given rectallu

Answer 31

Morphine | Oxycodone hydrochloride

Question 32

What are the main types of pain relief that can be given transdermally

Answer 32

Fentanyl | Buprenorphine

Question 33

If patients are on a transdermal patch what can be given for breakthrough pain

Answer 33

IR morphine

Question 34

What are the three formulations of transdermal patches

Answer 34

72 hourly 96 hourly 7 day patches

Question 35

How often are fentanyl patches on for

Answer 35

72 hours

Question 36

What three drugs are contraindicated for use in syringe drivers

Answer 36

Chlorpromazine hydrochloride Prochlorperazine Diazepam As the cause local irritation (Cyclizine and levomepromazine can also cause this)

Question 37

What is the usual infusion rate of a CSCI

Answer 37

0.1-0.3ml/hr

Question 38

What is the units of most pain reliefs

Answer 38

mg

Question 39

What type of morphine is given in a syringe driver and up to what max dose

Answer 39

Diamorphine (up to 250mg/ml)

Question 40

How do you give breakthrough pain relief in a patient with a syringe driver

Answer 40

Subcut or IM equivalent to 1/10 to 1/6 of the total 24 hour subcut infusion dose

Question 41

How do you minimise the risk of infection with syringe drivers

Answer 41

No subcut infusion solution should be used for longer than 24 hours

Question 42

What is the usual dose of the paracetamol

Answer 42

0.5-1g every 4-6 hours (max4g/ day)

Question 43

What is the dosage of paracetamol for people under 50kg o hepatotoxicity

Answer 43

15mg/kg every 4-6 hours

Question 44

What is the other indication for paracetamol

Answer 44

Pyrexia

Question 45

What are the two main cautions for paracetamol

Answer 45

Hepatotoxicity risk | Under 50kg

Question 46

When else should doses of paracetamol be reduced

Answer 46

With xoadministration of enzyme inducing anti epileptic meds in can increase risk of toxicity so doses should be reduced

Question 47

Paracetamol and EGFR less than 30

Answer 47

Make it 6 hours not 4

Question 48

What is the oral suspension of paracetamol

Answer 48

120mg/5ml 250mg/5ml 500mg/5ml

Question 49

What are the three preparations of cocodamol?

Answer 49

8/500 15/500 30/ 500

Question 50

What is the maximum doses of cocodamol per day?

Answer 50

64/4000 120/4000 240/4000

Question 51

What are the formulations of codeine

Answer 51

15mg 30mg 60mg

Question 52

What is the usual dose of codeine phosphate for pain

Answer 52

30-60mg every 4 hours (max 240mg per day)

Question 53

What drug should NOT be coprescribed with opioids

Answer 53

Benzos - can cause potentially fatal respiratory depression

Question 54

What are the main contraindications of opioids

Answer 54

``` Acute resp depression Comatose patients Head injury Raised IcP Risk of paralytic ileus ```

Question 55

What are common side effects of opioids (MORPHINE)

Answer 55

``` Miosis Out of it Resp depression Pruritus and pneumonia Hypotension and headache Infrequency (urinary retention and constipation) Nausea Emesis ``` Also arrhythmias and palpitations

Question 56

Opioids in hepatic and renal impairment

Answer 56

Caution in hepatic impairment | Don’t use in renal impairment

Question 57

What is the typical dose of tramadol

Answer 57

50-100mg every 4-6 hours (maximum dose is 400mg /24 hours)

Question 58

What is the initial adult dose of morphine for acute pain

Answer 58

10mg every 4 hours

Question 59

What is the usual dose for chronic pain

Answer 59

5-10mg every 4 hours